Prologue

April 8, 2001

I wasn’t surprised to wake up in a hospital, but then again I may not have been capable of feeling surprise at that particular moment. I absorbed my situation with interest but also a strange tranquil detachment. Somehow I had become an observer of my own life rather than a participant in it. A few days ago I had been going about my business in northern New Jersey like millions of other people. Now I was flat on my back with no idea of what had happened. Something told me that whatever it was had been huge and my life would never be the same, but there was no panic or anxiety. In fact I felt overwhelmingly calm and peaceful – calmer and more peaceful, than I could ever remember. Despite the enormity of whatever had taken place, there was no cause for alarm. My situation wasn’t good or bad – it simply was.

As I drifted to full consciousness, the conversation around me gelled into meaningful sound. It was a casual mix of medical terminology and personal chatter. I was in a hospital all right, but nothing in the nurses’ relaxed banter indicated that anything unusual or important was going on. One of them mentioned she was just finishing a twelve hour shift – and that she had come to this one directly from another twelve hour shift at a different hospital. I tried to process the concept of working 24 hours straight, but it only added to my confusion as I opened my eyes and tried to sit up.

* * *

The last thing I remembered was lying in my own bed at home with a splitting headache. Prior to that, most of the previous day had also been spent in a hospital, but unlike the profound tranquility I was now experiencing, it had been in a frenetic emergency ward where I had been yearning desperately for relief.

Thursday April 5th had begun like most days: out of bed at 6:15, out the door at 7:15, a half hour drive to work down I-287, smooth sailing most of the way to the office except for a brief backup crossing I-80, then a coffee and bagel at my desk around 8:00 to gear up for another day of meetings and phone calls on global pharmaceutical marketing projects. But that day, around 8:30, as I sat at my desk listening to a colleague talk about our business issues in Japan, a dull roar like a passing freight train suddenly erupted in my left ear. It only lasted a few seconds, but, noticing a strange look on my face, my colleague stopped mid-sentence and asked if I was all right. As a wave of nausea overwhelmed me I managed to gasp “no, get Garth” (our boss).

As soon as he left my office, I could not suppress the nausea any longer and threw up in the nearest thing handy, which happened to be my wastepaper basket. Then, my balance vanished. It wasn’t just a little off, it was gone completely. I could barely hold myself upright in my chair. If I hadn’t been sitting down already, I would have hit the floor like a sack of potatoes.

Within minutes, I was in an ambulance, and just a few minutes after that, the emergency ward of the nearest hospital. It had only been 20 minutes since the freight train had roared through my left ear. Thankfully, the overpowering nausea faded, but it was steadily replaced by the world’s worst headache. And there was no sign of my balance returning. I spent the next several hours under observation in the emergency ward – on a gurney with a wafer-thin mattress and surrounded by constant shouting. The shouting had nothing to do with me. As patients came and went throughout the day, many were elderly or confused, or both. They either shouted when they simply wanted to speak or were so hard of hearing, or disoriented, they were shouted at by the hospital staff in a largely futile attempt to communicate. In the meantime, a CAT scan of my brain hadn’t shown anything unusual and the ER physician couldn’t explain what had happened.

Eventually he concluded that a middle ear problem was causing vertigo and the solution was simple. Meclizine would restore my balance and the headache would eventually subside by itself. Until then, he said I could ease the intense pain in my head with any over-the-counter painkiller I liked. He was so sure of his diagnosis that he said it wasn’t necessary for me to remain in the hospital. Choosing between the discomfort, noise and confusion of the emergency ward and my soft comfortable bed in the peace and quiet of home wasn’t really a choice at all. So despite my pounding headache, and not being able to stand or walk without holding on to the walls, but with total confidence in the doctor’s diagnosis, I didn’t hesitate to sign myself out.

Since my car was still at the office, my friend Karolina, who also worked at the same company, was called to drive me home. When she arrived and saw me being delivered to the lobby in a wheelchair, she was outraged.

“How can you let him go like this?” she demanded, while I desperately just wanted to get out of there. “What if it happens again?”

“Call 911” the nurse said.

That turned out to be the best advice of the day.

 

At home with my precious meclizine, I took my first dose and went straight to bed in anticipation of relief. As I lay with my head on my pillow waiting for the drug to take effect, despite the skull-crushing pain I couldn’t help but be intrigued that the whole room appeared tilted like a crooked picture on a nail, but when I sat up, the room righted itself. And when I got out of bed, I still couldn’t manage a step without holding on to the furniture or walls.

As the hours went by, the meclizine wasn’t having the slightest effect, but I still had complete faith in it. Throughout the rest of the day and evening, my condition steadily worsened and my lucidity dwindled. Ironically, this prevented me from realizing just how bad things were becoming. Despite steady doses of ibuprofen, my head still felt like it was splitting in two. Being fairly familiar with ibuprofen from working in the pharmaceutical industry, I knew that the maximum recommended dose of this particular preparation was two tablets every four hours – so that’s what I took.

At least, that’s what I thought I was taking. In reality, the time between some doses was more like ten minutes. Not willing to leave until she saw some sign of improvement, Karolina had stayed through the night and played hooky from work the next morning. Although she was there solely out of concern for me, she was becoming increasingly annoyed that I was proving to be such a difficult patient. It didn’t occur to her that my thinking was now so scrambled that I couldn’t tell the difference between four hours and ten minutes.

Finally, she got fed up and placed the bottle of ibuprofen across the room where I could no longer reach it from my bed. I was to be conscious – or at least appear to be conscious – for several more hours, but her moving the ibuprofen sometime on Friday (more than 24 hours after the initial incident at my desk) was the last thing I remembered. As she told me later, eventually she heard a loud thud from my bedroom and came running. I had fallen – either attempting to get to the washroom, or, more likely, attempting to get to the ibuprofen. Despite my repeated insistence that I would be fine and there was no need to phone my parents in Toronto, or anyone else for that matter, Karolina had seen enough and dialled 911.

For the second time in three days, I was rushed to a hospital by ambulance. I had been extremely unlucky the first time because that particular hospital is actually renowned for its neurological department. People are flown there from all over the world for the latest state-of-the-art treatment. If I only could have gotten beyond its emergency ward, I would have been in the best possible hands. But now my luck was about to shift 180 degrees. In fact, as I lay languishing in bed at home my luck had already changed. Karolina staying with me, rather than simply dropping me off and heading off to do whatever she had been planning to do that evening was my first lucky break. Her ignoring me and calling 911 was my second. My third lucky break was nothing short of a miracle. A neurologist, Dr Arbab Hajjar, just happened to be hanging around the emergency ward of Chilton Memorial Hospital as I was wheeled in.

On the surface, my condition didn’t appear all that dire. I was still able to answer questions and hold a conversation with the admitting nurse. According to Karolina I even cracked a joke or two, but I don’t remember any of it. Dr Hajjar took one look at me and knew instantly that I was in serious trouble. He tagged along to the radiology department, literally looking over the ER doctor’s shoulder while another CAT scan was performed. This time, the results were unequivocal and he immediately assumed command. He later said that an MD without neurological training would not likely have recognized the grave danger I was in, even with the results of the CAT scan, and by the time the standard diagnostic procedure had been completed it would have been too late. He said that when I arrived at Chilton I had maybe 20 to 30 minutes of consciousness remaining. And if I had lost consciousness, he added, I would not have woken up – ever.

* * *

Instead, however, I was waking up. I could hear the nurses’ amiable chatter and I could feel all sorts of needles and tubes sticking into various parts of my body. Although I was still groggy, at least the wicked pain in my head was finally gone. As the world gradually came back into focus and I found myself a serene observer, in my tranquil state I thought it would be amusing to inconspicuously sit up and casually join in the conversation.

I had no idea that I was strapped down to prevent intravenous lines from being ripped out. So instead of discreetly sitting up, all I managed to do was shake the bed violently. Thinking I was confused and thrashing out of control, a nurse came running and said all in one breath: “Relax, you’ve had a stroke, they’ve done brain surgery, and your parents are on their way.”

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